膀胱小細胞癌案例報告

陳柏佑,李允仁,侯鎮邦,林友翔,楊佩珊,張慧朗,陳建綸,崔克宏

林口長庚醫院外科部泌尿科

Small Cell Carcinoma of the Urinary Bladder- A Case Report and Literature Review

Po-You Chen, Yun-Ren Li, Chen-Pang Hou, Yu-Hsiang Lin, Pei-Shan Yang, Phei-Lang Chang, Chien-lun Chen, and Ke-Hung Tsui

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan

Purpose:

To investigate a rare case of small cell carcinoma of the urinary bladder

Case Presentation:

A 50-year-old male was diagnosed with small cell carcinoma of bladder (SCCB) (mixed 1% urothelial carcinoma in situ), T2N0M0 (stage II). Neoadjuvant chemotherapy with two cycles of Etoposide plus Cisplatin (E+P) were given. Local recurrence of tumor and regional lymph node invasion were noted at follow-up, staging T3bN1M0. Radical cystectomy plus lymph node dissection were done.

Discussion:

Small cell carcinoma of the bladder (SCCB) is extremely rare, accounting for about 0.7% (0.35%-1.8%) of bladder malignancy. The majority of patients are male (sex ratio 5:1), and most patients are around 60 to 70 years old. Hematuria is the most common symptom, and dysuria to be the second. SCCB and small cell lung carcinoma (SCLC) are not distinguishable in histological and immunohistochemistry (IHC) staining. SCCB often appears together with other tumors. SCCB uses TNM staging system, same as transitional cell carcinoma (TCC). Most of the patient is diagnosed at advanced stage (T3-4/N+/M+). The main treatment modality for SCCB is derived from the treatment for SCLC, but radical cystectomy (RC) is often performed in SCCB. However, Cheng et al. in 2004 discovered no survival difference in 64 patients whether performed RC or not (5-year survival was 16% vs. 18%, respectively). Cisplatin plus etoposide is the main treatment for SCCB, analogous to the treatment for SCLC. A MD Anderson’s study had compared treating SCCB with neuroendocrine regime or TCC regime. Of the 12 patients treated with neuroendocrine regime, only 2 had SCCB when performing cystectomy. While of the 9 patients treated with TCC regime (MVAC), 6 still had SCCB when performing cystectomy. Mackey et al. in 1998 had shown on multivariate analysis that cisplatin-based chemotherapy was the only predictive factor for survival for SCCB patients. Neoadjuvant chemotherapy for SCCB had been studied in multiple studies and showed promising results. A MD Anderson’s retrospective study included 46 operable patients. 21 patients were treated with 4 cycles of neoadjuvant ifosfamide plus doxorubicin combing etoposide plus cisplatin; other 25 patients received surgery alone. 5-year survival was significantly higher in chemotherapy group (78% vs. 36%, respectively). In our case, neoadjuvant chemotherapy with 2 cycles of etoposide plus cisplatin (E+P) followed by radical cystectomy plus lymph node dissection were done. We should consider adding different regime chemotherapy, due the advanced stage of SCCB and poor response to standard E+P.

Conclusion: